Long-term urological follow-up of multicystic dysplastic kidneys: Is it still indicated in 2007?
1The Division of Pediatric Urology, Winnipeg Children's Hospital, Winnipeg, Man.
Insights
Long-term urological follow-up for children with isolated multicystic dysplastic kidneys (MCDK) is not supported by current literature. Primary care physicians can monitor blood pressure, and routine follow-up ultrasounds confirm diagnosis.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Multicystic dysplastic kidneys (MCDK) are a common congenital anomaly.
- Current clinical practice often involves long-term urological follow-up for children diagnosed with MCDK.
Purpose of the Study:
- To evaluate the evidence supporting current indications for long-term urological follow-up in children with MCDK.
- To determine if existing literature supports the common practices for managing MCDK.
Main Methods:
- A survey of Pediatric Urologists of Canada members assessed current follow-up practices and indications.
- A comprehensive literature search (PubMed, EMBASE, Conference Papers Index) was conducted to validate these indications.
Main Results:
- Most pediatric urologists surveyed follow children with MCDK long-term, citing risks of Wilms' tumor, hypertension, contralateral kidney observation, and MCDK involution.
- The literature search found no support for long-term urological follow-up for isolated unilateral MCDK.
- Primary care physicians can manage hypertension monitoring.
Conclusions:
- Long-term urological follow-up for children with simple, isolated MCDK is not evidence-based.
- Confirmation of diagnosis via renal ultrasound at 12-24 months is sufficient.
- Blood pressure monitoring by primary care physicians is recommended for these patients.
Objective:
To determine whether the current indications for the long-term urological follow-up of children with multicystic dysplastic kidneys (MCDKs) are supported by the literature.
Methods:
The membership of the Pediatric Urologists of Canada was surveyed to determine if long-term urological follow-up was being performed, and if so, for what indications. A literature search using PubMed, EMBASE and a Conference Papers Index was performed to determine whether the indications listed were supported by the literature.
Results:
A response rate of 72% was achieved for the survey, with most respondents following children with MCDK long-term. The main indications for long-term follow-up were the increased risk of Wilms' tumour (54%) and hypertension (32%), observation of the contralateral kidney (43%) and involution of the MCDK (36%). The literature search did not support long-term urological follow-up for any of these indications, provided unilateral MCDK was an isolated genitourinary abnormality. Although it is rare, a primary care physician could monitor for hypertension.
Conclusion:
Long-term urological follow-up of children with "simple MCDK" is not supported by the literature, provided the diagnosis has been confirmed with a follow-up renal ultrasound at 12-24 months. Blood pressure monitoring by a primary care physician is recommended.
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